Multiple deprivation and excess winter deaths in Scotland

Abstract

The recent publication of the Scottish Index of Multiple Deprivation (SIMD) has allowed some tentative statistical correlations to be undertaken to assess the impact poverty may have on mortality and morbidity. During the period 1989 to 2001, Scotland registered around 51,600 excess winter deaths (EWDs). An EWD is taken as the additional deaths during December to March than occurred in the preceding and subsequent four-month periods. Almost all of these EWDs were in the population aged over 65. This represents 50 more deaths per day in January than in July. The SIMD measured five criteria by region: income; employment; health and disability; education, skills and training; and geographical access to services. Glasgow was the most deprived region with an SIMD score of 46.88 and East Dunbartonshire, the least deprived region, with a score of 9.07. For the over 65s, the chance of becoming an EWD in Glasgow is one in 36, rising to one in 68 for North Ayrshire. The SIMD is positively correlated with EWD by region (0.35 at the 5% confidence level). This correlation appears to go against the influence of climatic variations, house type, energy efficiency and access to the gas network which favours urban areas. Although some of the additional winter deaths have been ascribed to outdoor cold exposure--exacerbated by inappropriate clothing or culturally determined behaviour--the majority of EWDs are premature and essentially preventable if the elderly can be kept warm in their homes during the winter months.

The health impacts of energy performance investments in low-income areas: a mixed-methods approach

“…Table 3 and Figure 4 show that the intervention was not significantly associated with a change in cardiorespiratory, COPD-related, cardiovascular or respiratory emergency admissions for people of all ages. The results include summaries of the raw, unadjusted data for the pre-and post-intervention phases, and the paired differences for those [18,527] 0.0543 (0.4788) [22,209] 0.0152 (0.9144) [12, [18,527] 0.0062 (0.1468) [22,209] 0.0054 (0.1526) [12, [18,527] 0.0179 (0.2709) [22,209] 0.0108 (0.5264) [12, [18,527] 0.0324 (0.3720) [22,209] 0.0045 (0.7374) [12, people who were in the study for both phases (irrespective of the lengths of residency periods). We subsequently included covariates and factors in univariate linear models for each outcome, and the adjusted comparisons are taken from models that retain all significant covariates and factors (listed at the end of Tables 3 and 4).…”

“…6,[10][11][12] Prolonged exposure to low temperatures can have an impact on blood pressure and blood chemistry [13][14][15] as well as blood viscosity and vasoconstriction. 16,17 Low temperatures can also suppress the function of the immune system, 18 raising the risk of respiratory infection among vulnerable groups. 10 Living in low temperatures has been linked to a higher prevalence of respiratory infections and hospital admissions among the elderly, [19][20][21] as well as to increased severity and frequency of asthmatic symptoms in children.…”

Making the connection: The relationship between fuel poverty, electricity disconnection, and prepayment metering

“…The health effects of fuel poverty include, but are not limited to, respiratory distress (Collins, 1993), exacerbation of respiratory conditions including asthma (Howden-Chapman et al, 2007 and chronic obstructive pulmonary disease (COPD) (Collins, 2000;Osman et al, 2008;Sherwood Burge, 2006), exacerbation of arthritic/rheumatic symptoms (Shortt and Rugkasa, 2007), accidental hypothermia particularly among older people (Critchley et al, 2007;Pedley et al, 2002;Roaf et al, 2005), increased risk of accidents in the home (Roaf et al, 2005), and increased risk of cardiovascular events caused by defence mechanisms triggered when the body is cold, which thicken the blood and increase blood pressure (Collins, 1993;Howieson and Hogan, 2005;Lan Chang et al, 2004). In a narrative synthesis of five recent intervention studies examining specific effects of cold housing on health, Liddell and Morris (2010) conclude that broader health and wellbeing measures may better capture the full range of benefits that improved housing conditions and heating are likely to have on human health.…”

The Great Scottish Housing Disaster: The Impacts of Feudalism, Modernism, Energy Efficiency and Vapour Barriers on Indoor Air Quality, Asthma and Public Health

“…The major causal factor therefore appears to be the inability of many UK subjects to adequately heat their homes to thermally safe [25] temperatures, due to a combination of poverty, inefficient or expensive fuel options/systems and historically poor insulation standards. When the Scottish Index of Multiple Deprivation SIMD [26] was correlated with excess winter deaths per region, a clear pattern emerged demonstrating that those living in "fuel poverty" in regions with a high SIMD were twice as likely to die in the winter months as those living in more affluent areas [27]. These deaths are rarely registered as hypothermic in nature.…”